Agenda item - Care Quality Commission Inspection Report: University Hospitals Sussex Maternity and Surgery Services at the Royal Sussex County Hospital

Report of the Executive Lead, Strategy, Governance & Law (copy attached)

22.1    This item was presented by Dr Maggie Davies, University Hospitals Sussex NHS Foundation Trust (UHS) Chief Nurse; Dr Andy Heeps, UHS Managing Director; and by Dr Charlotte Hopkins, UHS Chief Medical Officer. Dr Davies told the committee that the Care Quality Commission (CQC) had conducted an unannounced inspection of maternity at all four UHS general hospitals, and of surgery at the Royal Sussex County Hospital (RSCH), on 28 September 2021.

22.2    Following the inspections, a warning notice was issued to the Trust, requiring significant improvements be made in certain areas by 03 December 2021. Areas for urgent improvement included: the safe storage of medicines; the safe storage of patient records; infection prevention; and management of clinical risk. UHS undertook urgent actions in these areas by 03 December, and the CQC confirmed that they were content with the steps taken.

22.3    The CQC also required the Trust to take measures on governance and on safe staffing-levels by April 2022. UHS reports good progress to implementing the required actions here.

22.4    A QCQ oversight committee, chaired by Adam Doyle, the CE of the Sussex Integrated Care System (ICS), meets monthly to review the progress of UHS’s improvement work. Within the Trust, a CQC Improvement Working Group has been established which reports regularly to the UHS Board and to the UHS Quality Committee.

22.5    Cllr John noted that she would imminently be using RSCH maternity services. She asked questions about how improvement is being monitored and about recruitment. Dr Davies responded that there is a daily call with maternity units to ensure that safe staffing levels are maintained. There is also weekly monitoring of staff undertaking training and of recruitment. The Trust is in the process of recruiting more midwives and is making good progress in improving maternity despite the additional pressures of Covid on services. Dr Heeps added that the Trust’s focus is on supporting local leadership teams to drive improvement work. This includes re-building leadership teams where necessary, and offering incentives for staff to complete required training swiftly.

22.6    In response to a question from Cllr John on what the Trust is doing to involve staff more, Dr Davies told members that UHS has established a number of zoom listening events with both senior and more junior midwifery staff. A new Director of Midwifery has been appointed and will be starting soon. Senior leaders are also regularly visiting front-line units, and daily staff huddles are taking place at all units.

22.7    Cllr West asked a question about how confident that Trust was that it would improve as required given the long-standing problems in recruiting experienced staff. Dr Davies responded that the Trust is very busy, in part due to Covid and also to delays in discharging patients to the community or to care settings. However, UHS is working hard and innovatively on recruitment: e.g. by developing new staff roles in surgery which may be easier to recruit to. Dr Hopkins added that there is no quick-fix for recruitment, but that the Trust has recently been successful in recruiting some junior doctors and also mid-level locum medics who will free up consultants to do more teaching and training.

22.8    In response to a query from Cllr West on the lack of detailed data in the presentation to the HOSC, Dr Davies noted that much more granular data is examined by the CQC Oversight Committee. Dr Hopkins added that quantitative data is important, but so is qualitative data – e.g. peer review. This type of activity has been limited by the need to respond to Covid, but will be resumed as soon as feasible. The Chair asked if it was possible for more data to be shared with the committee, and Dr Davies said she would check and respond at a later date.

22.9    Cllr McNair asked a question about the relative impact of staff shortages on managers and front-line staff at RSCH. Dr Heeps responded that most management at the hospital is in fact by front-line clinicians. There are shortages in both management and the front-line, and Covid has impacted on the ability of clinicians to carry out managerial duties in addition to their clinical work. The Trusts vacancy rate is currently around 7%, although this varies across staff groups and areas. However, it needs to be understood that some staff want to work additional hours or bank shifts even in normal circumstances, and that this is factored into recruitment management, hence Trusts typically expect to work with some level of vacancies to accommodate this. Covid has caused a specific staffing problem in that the staff most qualified to meeting increased intensive care demand are theatre staff, so Covid demands have a disproportionate impact on theatre activity.

22.10  Cllr Wilkinson asked a question about disproportionate impacts of staffing issues on patients from black and minority ethnic communities using maternity services. Dr Heeps responded that there are no inherent maternity risks linked to ethnicity. However, there is a recognised heightened risk to some black and minority ethnic patients if they do not receive continuity of care. The Trust is working hard to address this and to implement the recommendations of the Ockendon report. Dr Davies added that an exemplar midwife is working at RSCH and this is delivering good results.

22.11  In response to a question from Cllr Wilkinson on what can be done to tackle surgical backlogs, Dr Heeps noted that delays in discharging patients from hospital have a significant impact on the Trust’s ability to deal with backlogs. This is something that the Council can help with.

22.12  Cllr Colin Belsey, Chairman of East Sussex HOSC, asked whether the merger of Brighton & Hove University Hospitals Trust and Western Sussex  Hospitals NHS Foundation Trust had impacted on performance. Dr Heeps responded that it was difficult to assess this, as the merger coincided with the Covid emergency. However, looking forward, the merger offers opportunities to share good practice across the Trust and to more easily arrange and deliver staff training. A key factor in the success of the merged Trust will be to ensure that local leadership is supported.

22.13  Mr Garry Wall, Chairman of West Sussex HASC, thanked the Chair for inviting him to this meeting and noted that it would provide a useful basis for West Sussex HASC’s own scrutiny of UHS improvement plans.

22.14  The Chair asked a question about issues with staffing and recruitment of maternity at RSCH, and what the Council could do to help. Dr Heeps responded that there is a national shortage of midwives which results in push-pull problems across the UK (i.e. when one area is successful in recruiting this tends to have a negative impact on other areas). Problems specific to Brighton & Hove include its geographically limited catchment due to being bounded by the sea to the South, and its proximity to London where wages are significantly higher. Staff retention bonuses can help here, as can more joined-up work with the Medical Schools. However, key is ensuring that RSCH remains a good place to work. Dr Davies added that Covid is still having a short-term impact on staffing levels, but that the situation is improving. Operating across four hospital sites is a positive as it provides lots of room to flex staffing to ensure that there are enough staff at each site at any given time. Dr Hopkins noted that, whilst Covid restrictions were beginning to ease in general society, the situation in healthcare settings was different. Public Health messaging that reminded members of the public attending hospital to wear masks would be helpful.

22.15  Cllr Deane noted that she would like to see an update on the situation at UHS soon. The Chair agreed, noting that the committee had received a good deal of assurance, but that there were still significant concerns, and that the committee needed to see more data on improvement. Dr Davies noted that the next major performance reporting deadline was the end of April, so it might make sense to schedule an update after this. The Chair said that she would liaise with the Trust to identify a suitable date for an update, but that she might herself meet UHS in the interim. The Chair thanked the presenters for attending the meeting.

22.16  RESOLVED – that the report be noted.